Prenatal diagnosis of microcephaly with simplified gyral pattern: series of eight cases

Microcephaly with simplified gyral pattern (MSG) is an intrinsic genetic central nervous system disorder, characterized by microcephaly (a reduction of brain volume) and a simplified gyral pattern (a reduced number of gyri and shallow sulci associated with normal cortical thickness and neuroanatomical architecture), related to a reduced number of neuronal progenitors in the germinal matrix. We report the first prenatal series of MSG and define the prenatal imaging pattern, which should inform diagnosis and guide prenatal counseling in cases of fetal microcephaly. In this single-center retrospective study of fetuses with MSG, we assessed features on ultrasound and magnetic resonance imaging (MRI), as well as genetic and neuropathological/postnatal data. We included eight patients who had been referred following observation of microcephaly. Ultrasound examination confirmed microcephaly, with a mean growth delay in head circumference of 3.4 weeks, associated with both a lack of gyration and a lack of opercularization of the Sylvian fissure and without any extracephalic anomaly. Fetal brain MRI confirmed lack of gyration with normal cortical thickness and normal intensity of the white matter in all cases. These MRI features led to exclusion of migration/corticogenesis disorders (lissencephaly/polymicrogyria), instead suggesting MSG. The posterior fossa was normal in seven of the eight cases. The corpus callosum was thin in four cases, hypoplastic in two and dysgenetic in two. In four cases, the pregnancy was terminated. The diagnosis of MSG was confirmed from neuropathological and postnatal MRI data. MSG was associated with a genetic diagnosis of RTTN (n = 1) and ASPM (n = 2) biallelic variants in three of the six cases in which genetic work-up was performed. Mild or moderate intellectual deficit with speech delay was present in the three surviving children who were at least 5 years of age at their last examination, without seizures. In conclusion, in the presence of isolated fetal microcephaly with lack of gyration on ultrasound, fetal cerebral MRI is key to diagnosing MSG, which, in the majority of cases, affects the supratentorial space exclusively, and to ruling out other cortical malformations that show a similar sonographic pattern. In addition to imaging, genetic assessment may guide prenatal counseling, since the prenatal prognosis of MSG is different from that of both diffuse polymicrogyria and lissencephaly. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Arterial Spin-Labeling in the Assessment of Pediatric Nontraumatic Orbital Lesions

Benign and malignant pediatric orbital lesions can sometimes have overlapping features on conventional MR imaging sequences. MR imaging of 27 children was retrospectively reviewed to describe the signal of some common pediatric extraocular orbital lesions on arterial spin-labeling and to evaluate whether this sequence helps to discriminate malignant from benign masses, with or without ADC value measurements. Qualitative and quantitative assessments of arterial spin-labeling CBF and ADC were performed. All lesions were classified into 3 arterial spin-labeling perfusion patterns: homogeneous hypoperfusion (pattern 1, n = 15; benign lesions), heterogeneous hyperperfusion (pattern 2, n = 9; cellulitis, histiocytosis, malignant tumors), and homogeneous intense hyperperfusion (pattern 3, n = 3; infantile hemangiomas). Arterial spin-labeling can be a valuable tool to improve the diagnostic confidence of some orbital lesions, including infantile hemangioma. An algorithm is proposed.

Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department

Objectives

The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time.

Methods

TDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field.

Results

Overall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals.

Conclusions

The greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.

Dexmedetomidine sedation vs. inhaled general anesthesia for pediatric MRI: A retrospective cohort study: Dexmedetomidine sedation vs. inhaled general anesthesia for MRI

OBJECTIVES

The objective of this study was to evaluate the feasibility and the efficacy of a dexmedetomidine-based protocol followed by anesthesiologists unaccustomed to using dexmedetomidine during pediatric magnetic resonance imaging (MRI) examinations compared to conventional halogenated general anesthesia.

METHODS

This was a single-center retrospective cohort study including patients younger than 18 years who underwent sedation for MRI between August 1, 2018 and March 31, 2019. Patients who received dexmedetomidine were included in the DEX group and patients who had general anesthesia formed the GA group. Patients were matched with a ratio of 2 GA:1 DEX, based on age and type of MRI examination.

RESULTS

Overall, 78 patients were included (DEX=26; GA=52). Dexmedetomidine was significantly associated with a decrease in invasive ventilation (p<0.001) with no impact on image quality. The sedation failure rate was 42% with dexmedetomidine vs. 0% with general anesthesia (p<0.001). All cases of failure followed the intranasal administration of dexmedetomidine.

CONCLUSION

Dexmedetomidine seems to be a suitable sedation option for pediatric MRI. It provides an alternative to halogenated general anesthesia with the aim of limiting exposure to conventional anesthetic agents and invasive ventilation.

Transdiagnostic internet cbt for mixed anxiety and depressive: Results from a feasibility study in primary care

Introduction

In response to the treatment gap for anxiety and depressive disorders, psychological treatments with innovative modalities and high implementation potential are essential. Internet CBT (iCBT) is a cost/effective approach that could improve access to a low-intensity evidence-based CBT intervention.

Objectives

To assess the feasibility and acceptability of the French adaptation of the physician-prescribed six-lesson This Way Up transdiagnostic iCBT program for mixed anxiety and depressive disorders developed in Australia.

Methods

Feasibility study with pre- post-intervention evaluations, including an embedded qualitative study in Family Medicine Groups (Quebec, Canada). Inclusion criteria comprise a family physician diagnosis of Major Depression, Panic Disorder, Agoraphobia, Social Anxiety Disorder or Generalized Anxiety Disorder. Primary self-reported outcomes: PHQ-9 (depression) and GAD-7 (anxiety); secondary measures include diagnostic-specific scales and health service utilisation.

Results

Family physicians (N=21) from five Family Medicine Groups prescribed iCBT to 45 patients (30 women, 15 men; mean age = 39.7), 31 initiated the program. To date, 20 patients completed 5 or 6 lessons, nine completed between 2 and 4. Intervention and post-treatment assessments are ongoing, results forthcoming. Results of semi-structured interviews with patients (N=15) and family physicians (ongoing) on iCBT acceptability indicate it is beneficial, practical and easy to use. Program adherence requires patient readiness and determination and could be fostered by motivational support from clinicians.

Conclusions

Results support this French iCBT program’s scaling-up potential to contribute to reducing the gap in evidence-based treatments for common mental disorders. Its implementation in primary care could improve the effectiveness, efficiency and equity to a rapidly accessible treatment.

Enhanced light extraction efficiency of Eu-related emission from a nano-patterned GaN layer grown by MOCVD

Eu-doped GaN is a promising material for the active layer in red light emitting diodes. Although the output power of LEDs based on GaN:Eu has been increasing by a combination of structural and growth optimizations, there is still a significant limitation resulting from a poor light extraction efficiency, typical for high refractive index materials. Here we studied nanostructuring of the top of the optical active layer by nano-cubes for enhancement of the light extraction efficiency, and its effect on the optical emission characteristics. By etching nano-cubes into the active layer, we observed an increase in directional light output power of Eu³⁺ ions of up to 60%, as well as a grating effect. Simultaneously, the absorption of excitation light into the optical active layer was improved, leading to a 12.8 times increase of output power per available Eu³⁺ ion.

Information for mental health systems: an instrument for policy-making and system service quality

AIMS

Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward.

METHODS

Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries.

RESULTS

Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models.

CONCLUSIONS

Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited application of information. Corrective action is needed to upgrade data collection in outpatient facilities, to improve data quality, to establish clear rules and norms, to access adequate information technology equipment and to train health care personnel in data collection. Moreover, it is necessary to shift from mere administrative data collection to analysis, dissemination and use by relevant stakeholders and to develop a "culture of information" to dismantle the culture of intuition and mere tradition. Clinical directors, mental health managers, patient and family representatives, as well as politicians should be educated to operate with information and not just intuition.

The DSM5/RDoC debate on the future of mental health research: implication for studies on human stress and presentation of the signature bank

In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social "signatures" of mental disorders. Along with this new "signature" approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorporated in the last version of the DSM5. Consequently, the NIMH launched the "Research Domain Criteria" (RDoC) framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the "Signature Bank" developed by the Institut Universitaire en Santé Mentale de Montréal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness.

Comparative effectiveness and safety of antipsychotic drugs in schizophrenia treatment: a real-world observational study

OBJECTIVE

The objective was to compare, in a real-world setting, the risk of mental and physical health events associated with different antipsychotic drugs (clozapine, olanzapine, risperidone, quetiapine and first-generation antipsychotics) in patients with SZ.

METHODS

This is a retrospective cohort study using administrative data. Outcome measures included any mental health event (suicide, hospitalization or emergency visit for mental disorders) and physical health event (death other than suicide, hospitalization or emergency visit for physical disorders). Cox proportional hazard models were used to estimate the hazard ratios of the events associated with the use of the different antipsychotic drugs.

RESULTS

The cohort included 18 869 adult patients living in the province of Quebec (Canada) with SZ and starting antipsychotic drugs between January 1998 and December 2005. Results show that quetiapine and not using any antipsychotics were associated with an increased risk of mental and physical health events as compared to other drugs. The second finding is the confirmation of better performance of clozapine. The results were robust across sensitivity analyses.

CONCLUSION

Both findings call for an international public health and drug agencies surveillance of 'real-world' antipsychotic medication to ensure the optimal choices in treatment guidelines for SZ.

Cubic three-dimensional hybrid silica solids for nuclear hyperpolarization

Porous network architecture of hybrid silicas containing TEMPO radicals along their pores is key for increased hyperpolarization performances.

Hyperpolarization of metabolites by dissolution dynamic nuclear polarization (D-DNP) for MRI applications often requires fast and efficient removal of the radicals (polarizing agents). Ordered mesoporous SBA-15 silica materials containing homogeneously dispersed radicals, referred to as HYperPolarizing SOlids (HYPSOs), enable high polarization – P(¹H) = 50% at 1.2 K – and straightforward separation of the polarizing HYPSO material from the hyperpolarized solution by filtration. However, the one-dimensional tubular pores of SBA-15 type materials are not ideal for nuclear spin diffusion, which may limit efficient polarization. Here, we develop a generation of hyperpolarizing solids based on a SBA-16 structure with a network of pores interconnected in three dimensions, which allows a significant increase of polarization, i.e. P(¹H) = 63% at 1.2 K. This result illustrates how one can improve materials by combining a control of the incorporation of radicals with a better design of the porous network structures.

Prevalence, mortality and healthcare utilization of cluster B personality disorders in Quebec: A province cohort study, 2001–2012

Background

Cluster B personality disorder (PD) is a highly prevalent mental health condition in general population (1 to 6% depending on the subtype and study). Patients affected are known to be heavier users of both mental and medical healthcare than other clinical conditions such as depression. Few studies have highlighted their elevated mortality rate compared to general population.

Methods

The estimates were produced using data from the integrated monitoring system for chronic disease of Quebec. It provides annual and life prevalence, mortality rate, years of and healthcare utilization profile Quebec inhabitants.

Results

A total of 7,995,963 people were included in the study. The life prevalence of cluster B PD is 2.6%. The mean years of lost life is 13 for men and 9 for women when they are compared to general population. The 3 most important causes of death are: suicide (20.4%), cardiovascular diseases (19.1%) and cancers (18.6%). The standardized mortality ratio (SMR) for each medical condition is superior in cluster B personality disorders than general population. The most important SMR is for suicide (male: 10.2 and female: 21). In the year 2011–2012, 78% had consulted a general practitioner, 62% a psychiatrist, 41% were admitted in an emergency department and 21% were hospitalized.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Factor analysis of the French version of the shorter 12-item Perception of Aggression Scale (POAS) and of a new modified version of the Overt Aggression Scale (MOAS)

Psychiatric staff perceptions of aggression by psychiatric patients may affect the therapeutic relationship between care providers and patients in institutions. Attitudes to and the subjective experience of violence may also differ substantially between members of a single care team. This study seeks to validate the French versions of scales of staff attitudes to and subjective experience of institutional violence: a new, modified version of the Overt Aggression Scale (MOAS) to measure the subjective perception of the frequency of aggression in the ward; and the Perception of Aggression Scale (POAS) to assess attitudes to the expression of violence by psychiatric patients. Frontline staff (n = 362) from eight French-language psychiatric institutions in the province of Quebec were surveyed. Factor analyses were performed to determine the validity of the French-language MOAS and POAS. As expected, a four-factor structure emerged for the MOAS. For the 12-item POAS, a three-factor structure was found: (1) 'Aggression as a dysfunctional/undesirable phenomenon'; (2) 'Aggression as a positive expression'; and (3) 'Aggression as a protective measure'. This study supports use of the French MOAS and POAS in assessing staff attitudes to and subjective experience of aggression in future projects to explore the perception and management of inpatient violence.

Types of smokers in a community sample of individuals with Type 2 diabetes: a latent class analysis

AIMS

Despite the detrimental effects of smoking on their health, a high number of adults with Type 2 diabetes continue to smoke. Identifying distinct types of smokers within this population could help tailor and target intervention programmes. This study examined whether smokers with Type 2 diabetes could be classified into different profiles based on smoking habits, socio-economic characteristics and lifestyle factors.

METHODS

A sample of adults with self-reported diabetes was selected from random-digit dialing. Analyses included 383 participants with Type 2 diabetes who were current smokers. Information related to smoking, socio-economic status, health and lifestyle was collected by phone interview at baseline and 1 year later. Latent class analysis was used to identify subgroups of smokers.

RESULTS

We uncovered three meaningful classes of smokers: class 1, long-time smokers with long-standing diabetes (n = 105); class 2, heavy smokers with deprived socio-economic status, poor health and unhealthy lifestyle characteristics (n = 105); class 3, working and active smokers who were more recently diagnosed with diabetes (n = 173). Members of class 2 were significantly more likely to be disabled and depressed at baseline and 1 year later compared with other classes.

CONCLUSIONS

Different profiles of smokers exist among adults with Type 2 diabetes, each suggesting different cessation treatment needs. Distinguishing between these types of smokers may enable clinicians to tailor their approach to smoking cessation.

Reorganization based on patient focused care programs, in the context of mental health services reform: Effects on patients

Background

WHO (2001) suggested that the population should get easier and faster access to services improvements in the management of mental disorders in primary health care. In this context, the Government of Quebec (Canada) published in 2005 a Mental Health Action Plan, based on an organization into a hierarchy and some hospitals began to reorganize their mental health services into patient focused care programs.

Aims of the study

The presentation will focus on the effects on outpatients (N = 290) who were receiving mental health services from two hospitals in Montreal.

Methods

As part of a broader study on mental health services and patient outcomes, mental health services’ patients from a psychiatric hospital and a general university hospital in Montreal, were recruited to complete the Basis24, Euroqol, SF12 and other scales. A standard recruitment protocol was followed. All incoming patients at the outpatient clinics/programs during a typical week were considered eligible. This procedure was done before the reorganization of services, in 2006 (T1), and after the reorganization of services (T2; 2 years later), in 2008. We used T-test to assess the difference of a six-month evolution between the two-time measures.

Results

Respectively, 1057 (T1) and 557 (T2) participated to the project. Generally patients showed no significative differences between the two times in their symptoms, functioning and QOL. Only some marginal aspects changes in one site or another.

Conclusion

Patients were not very disturbed by changes and the new program were not fully implemented two years after T1.

Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder

Non-compliance with pharmacotherapy among persons suffering from schizophrenia disorders stands at an average rate of 42% and is the subject of numerous studies. However, no studies to date have addressed the specific question of non-compliance with psychosocial treatment. The present study therefore aimed to determine the rate of drop-out from psychosocial treatment and to assess the influence of factors on this rate.

METHOD

A meta-analysis was conducted based on 74 studies of randomized clinical trials on psychosocial treatment among persons suffering from schizophrenia spectrum disorder.

RESULTS

A drop-out rate of 13% was obtained. Age, gender, duration of illness, duration of treatment, treatment setting and study quality affected drop-out rates.

CONCLUSION

The 13% rate of drop-out from psychosocial treatment is markedly lower than the drop-out rate from pharmacotherapy studies. This finding supports the feasibility of evidence-based psychosocial treatment - which has, moreover, clearly been shown to be clinically effective - as part of a complete care program for schizophrenia.

Obesity and weight gain in relation to depression: findings from the Stirling County Study

OBJECTIVE

This study concerns the question of whether obese subjects in a community sample experience depression in a different way from the nonobese, especially whether they overeat to the point of gaining weight during periods of depression.

DESIGN

A representative sample of adults was interviewed regarding depression and obesity.

SUBJECTS

The sample consisted of 1396 subjects whose interviews were studied regarding relationships between obesity and depression and among whom 114 had experienced a major depressive episode at some point in their lives and provided information about the symptoms experienced during the worst or only episode of major depression.

MEASUREMENTS

The Diagnostic Interview Schedule (DIS) was used to identify major depressive episodes. Information was also derived from the section on Depression and Anxiety (DPAX) of the Stirling Study Schedule. Obesity was calculated as a body mass index >30. Logistic regressions were employed to assess relationships, controlling for age and gender, by means of odds ratios and 95% confidence intervals.

RESULTS

In the sample as a whole, obesity was not related to depression although it was associated with the symptom of hopelessness. Among those who had ever experienced a major depressive episode, obese persons were 5 times more likely than the nonobese to overeat leading to weight gain during a period of depression (P<0.002). These obese subjects, compared to the nonobese, also experienced longer episodes of depression, a larger number of episodes, and were more preoccupied with death during such episodes.

CONCLUSIONS

Depression among obese subjects in a community sample tends to be more severe than among the nonobese. Gaining weight while depressed is an important marker of that severity. Further research is needed to understand and possibly prevent the associations, sequences and outcomes among depression, obesity, weight gain and other adversities.

The relationship between work stress and mental disorders in men and women: findings from a population-based study

OBJECTIVES

[corrected] This analysis estimated the gender-specific associations between work stress, major depression, anxiety disorders and any mental disorder, adjusting for the effects of demographic, socioeconomic, psychological and clinical variables.

METHODS

Data from the Canadian national mental health survey were used to examine the gender-specific relationships between work stress dimensions and mental disorders in the working population (n = 24,277). Mental disorders were assessed using a modified version of the World Mental Health - Composite International Diagnostic Interview.

RESULTS

In multivariate analysis, male workers who reported high demand and low control in the workplace were more likely to have had major depression (OR 1.74, 95% CI 1.12 to 2.69) and any depressive or anxiety disorders (OR 1.47, 95% CI 1.05 to 2.04) in the past 12 months. In women, high demand and low control was only associated with having any depressive or anxiety disorder (OR 1.39, 95% CI 1.05 to 1.84). Job insecurity was positively associated with major depression in men but not in women. Imbalance between work and family life was the strongest factor associated with having mental disorders, regardless of gender.

CONCLUSIONS

Policies improving the work environment may have positive effects on workers' mental health status. Imbalance between work and family life may be a stronger risk factor than work stress for mental disorders. Longitudinal studies incorporating important workplace health research models are needed to delineate causal relationships between work characteristics and mental disorders.

Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide

BACKGROUND

It is unclear whether the association between impulsive-aggressive behaviours and suicide exists across different ages.

METHOD

Via psychological autopsy, we examined a total of 645 subjects aged 11-87 years who died by suicide. Proxy-based interviews were conducted using the SCID-I & SCID-II or K-SADS interviews and a series of behavioural and personality-trait assessments. Secondarily, 246 living controls were similarly assessed.

RESULTS

Higher levels of impulsivity, lifetime history of aggression, and novelty seeking were associated with younger age of death by suicide, while increasing levels of harm avoidance were associated with increasing age of suicide. This effect was observed after accounting for age-related psychopathology (current and lifetime depressive disorders, lifetime anxiety disorders, current and lifetime substance abuse disorders, psychotic disorders and cluster B personality disorders). Age effects were not due to the characteristics of informants, and such effects were not observed among living controls. When directly controlling for major psychopathology, the interaction between age, levels of impulsivity, aggression and novelty seeking predicted suicide status while controlling for the independent contributions of age and these traits.

CONCLUSIONS

Higher levels of impulsive-aggressive traits play a greater role in suicide occurring among younger individuals, with decreasing importance with increasing age.

Dinitrogen Dissociation on an Isolated Surface Tantalum Atom

Both industrial and biochemical ammonia syntheses are thought to rely on the cooperation of multiple metals in breaking the strong triple bond of dinitrogen. Such multimetallic cooperation for dinitrogen cleavage is also the general rule for dinitrogen reductive cleavage with molecular systems and surfaces. We have observed cleavage of dinitrogen at 250 degrees C and atmospheric pressure by dihydrogen on isolated silica surface-supported tantalum(III) and tantalum(V) hydride centers [(identical with Si-O)2Ta(III)-H] and [(identical with Si-O)2Ta(V)H3], leading to the Ta(V) amido imido product [(identical with SiO)2Ta(=NH)(NH2)]: We assigned the product structure based on extensive characterization by infrared and solid-state nuclear magnetic resonance spectroscopy, isotopic labeling studies, and supporting data from x-ray absorption and theoretical simulations. Reaction intermediates revealed by in situ monitoring of the reaction with infrared spectroscopy support a mechanism highly distinct from those previously observed in enzymatic, organometallic, and heterogeneous N2 activating systems.

Transverse dephasing optimized solid-state NMR spectroscopy

It is shown how coherence lifetimes in solid-state NMR experiments can be controlled. New decoupling schemes are introduced which actively optimize dephasing times, providing increases of up to a factor of 2 with respect to the best existing schemes. The new schemes are implemented in transverse-dephasing-optimized (TDOP) NMR experiments for the disorded solid cellulose, and for a microcrystalline protein, where sensitivity improvements of up to a factor of 5 are obtained.

Corticosteroids as adjunctive treatment in Austrian's syndrome (pneumococcal endocarditis, meningitis, and pneumonia): report of two cases and review of the literature

This report describes two cases of Osler's triad of pneumonia, meningitis, and endocarditis, as a result of Streptococcus pneumoniae infection, also called Austrian's syndrome. In the first patient, a 51 year old non-alcoholic man, the aortic valve was affected and needed to be replaced in an emergency operation. The mitral valve was affected in a 70 year old woman without underlying disease, who only benefited from medical treatment. Both patients received corticosteroids, either dexamethasone followed by low doses of hydrocortisone and fludrocortisone, or only hydrocortisone and fludrocortisone, at the onset of the illness, and their outcome was favourable. These case reports focus on the presentation, prognosis, and therapeutic options for this severe syndrome.

Patterns of co-morbidity in male suicide completers

BACKGROUND

Psychiatric co-morbidity is thought to be an important problem in suicide, but it has been little investigated. This study aims to investigate patterns of co-morbidity in a group of male suicide completers.

METHOD

One hundred and fifteen male suicide completers from the Greater Montreal Area and 82 matched community controls were assessed using proxy-based diagnostic interviews. Patterns of co-morbidity were investigated using latent class analysis.

RESULTS

Three subgroups of male suicide completers were identified (L2 = 171.62, df = 2012, P < 0.05). they differed significantly in the amount of co-morbidity (Kruskal-Wallis chi2 = 71.227, df = 2. P < 0.000) and exhibited different diagnostic profiles. Co-morbidity was particularly found in subjects with disorders characterized by impulsive and impulsive-aggressive traits, whereas subjects without those traits had levels of co-morbidity which were not significantly different from those of controls (chi2 = 8.17, df = 4, P = 0.086).

CONCLUSIONS

Suicide completers can be divided into at least three subgroups according to co-morbidity: a low co-morbidity group, a substance-dependent group and a group exhibiting childhood onset of psychopathology.

Hyperreninemic hypoaldosteronism: a possible etiological factor of septic shock-induced acute renal failure

OBJECTIVE

Hyperreninemic hypoaldosteronism has been described in critically ill patients. The present study investigated the plasma aldosterone concentration (PAC) in septic shock patients and its relationship with clinical course.

DESIGN AND SETTING

Prospective descriptive study in a medical intensive care unit (ICU) of a university hospital.

PATIENTS

Forty-six consecutive patients with septic shock as defined by the ACCP/SCCM criteria.

INTERVENTION

A corticotropin stimulation test, followed by treatment with low doses of hydrocortisone and fludrocortisone.

MEASUREMENTS AND RESULTS

Plasma renin activity, PAC, and cortisol levels were measured before and after the test. PAC measurements were repeated for 1 week. Relevant clinical and laboratory variables were recorded for ICU stay. Patients were divided into two groups according to PAC/renin activity ratio: above 2 (n=24 patients) and below 2 n=22). Patients with PAC/renin activity less than 2 had higher total volume of infused fluid, serum creatinine level, and fractional excretion of sodium values; aldosterone and serum creatinine were negatively correlated. Hypoaldosteronism was reversible within 1 week. Duration of ICU stay (p=0.0026) and the need for renal replacement therapy (p=0.0021) were greater in the group with PAC/renin less than 2.

CONCLUSIONS

Transient hyperreninemic hypoaldosteronism is common in patients with septic shock. These abnormal aldosterone levels are associated with greater sodium and fluid depletion and are followed by enhanced incidence of acute renal failure requiring renal replacement therapy and prolonged length of stay in ICU.

Suicide and serotonin: study of variation at seven serotonin receptor genes in suicide completers

Suicide is an important public health problem, accounting for a significant proportion of total mortality among young people, particularly males. There is growing and consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide. Based on several lines of evidence supporting a reduced serotonergic neurotransmission in subjects who committed suicide, we investigated variation at genes that code for serotonin receptor 1B (5-HTR1B), 1Dalpha (5-HTR1Dalpha), 1E (5-HTR1E), 1F (5-HTR1F), 2C (5-HTR2C), 5A (5-HTR5A), and 6 (5-HTR6) in a total sample of 106 suicide completers and 120 normal controls. No differences were observed in allelic or genotypic distributions between groups for any of the loci investigated. Moreover, further analysis according to suicide method or psychopathology also failed to reveal differences between groups. Our results do not support a substantial role of these serotonergic receptors in suicide completion.

[French validation of the Verona Service Satisfaction Scale-VSSS-54F]

INTRODUCTION

The Verona Service Satisfaction Scale-French version (13) was translated and adapted from the Italian version of Verona Service Satisfaction Scale (27). The VSSS makes it possible to evaluate the satisfaction of people with serious mental illness with respect to the services. The original VSSS-54 contained 7 dimensions: 1) Overall satisfaction, 2) Professionals' skills and behaviour, 3) Information, 4) Access to services, 5) Services efficacy, 6) Relatives' involvement and 7) Types of interventions. According to factorial analyses carried out by Ruggeri et al., the dimensions Information and Access to services were aggregated. However, no factorial analysis was carried out in order to verify the six dimension-structure of the VSSS. From an international perspective, the study entitled "The European Psychiatric Services: Inputs linked to Outcome Domains and Needs (EPSILON)" achieved the standardisation of different questionnaires in several languages (2). A new version of the VSSS entitled "Verona Service Satisfaction Scale-European version" (VSSS-EU) was developed and is now available in the following languages: Italian, Danish, German, English and Spanish. In order to compare in different countries the satisfaction of people with serious mental illness with respect to services, we undertook from 1998 to ascertain the psychometrical properties of the French version of the VSSS. (13). Confirmatory Factorial Analysis (CFA) was carried out on the six dimension-structure of the VSSS-54F: 1) Overall satisfaction, 2) Professionals' skills and behaviour, 3) Information and Access to services, 4) Services efficacy, 5) Relatives involvement and 6) Types of interventions. For each dimension, consistency analysis (Cronbach's alpha) was computed in order to bring forth additional psychometrical properties of the VSSS-54F.

METHOD

PARTICIPANTS

150 clients involved in an intensive case management program and supported by 30 mental health workers, filled out the VSSS-54F questionnaire. These clients were comprised of 110 women and 40 men, their ages ranging from 22 to 90 years (M = 51.7, SD = 14.7). Among them, 65 (43.3%) had a diagnosis of schizophrenia or another form of psychosis, 56 (37.3%) had an affective disorder, 17 (11.3%) had anxious disorders and 7 (7.7%) other.

DATA ANALYSES

Using the EQS Software (3), Confirmatory Factor Analyses (CFA) were carried out in this study. Thus, 'the evaluation of the models' fit with the empirical data was carried out by taking into account various statistical indices. In addition to the Chi square/df ratio, the indices of adjustment such as the "NonNormed Fit Index" (NNFI), the Comparative Fit Index (CFI), robust CFI (calculated starting from the Satorra-Bentler Chi Square) as well as the RMSEA (Root Mean Standard Error of Approximation) were used to measure the fit of the models. Moreover, the estimation method "Maximum Likelihood-Robust" was carried out in order to evaluate the models.

RESULTS

The original model with 6 dimensions (M1) does not present satisfactory fit indices. Indeed, the Chi Square/df ratio is above 2, the NNFI, CFI and CFI robust indices are lower than. 90 and the RMSEA is higher than. 08. Most items from Types of intervention dimension presented saturation lower than.30, and consequently indicate that these items are not correlated significantly with their dimension. We notice also some correlations between error terms of the three items of Overall Satisfaction scale and other items of the VSSS questionnaire. Considering these last results and the direction taken in VSSS-EU by breaking down by profession items of Professionals' skills and behaviour scale, we obtained a new model (M2). The five dimensions of this model are as follow: 1) Psychiatrists/Psychologists' skills and behaviour (7 items), 2) Nursing staff/social workers' skills and behaviour (7 items), 3) Information and access to services (3 items), 4) Services efficacy (5 items), 5) Relatives' involvement (3 items). When we test this model, the fit indices are satisfactory: the Chi Square/df is 1.36, the NNFI, CFI and robust CFI indices are near or higher than 0.90, respectively 0.88, 0.89 and 0.94. Finally, the RMSEA index is 0.08. In addition, the correlations between five dimensions are significant and vary from 0.58 to 0.87 (p < 0.05). The internal consistency coefficients for each new scale are all satisfactory, and vary from .83 to .91, except for the Information and access to services scales. But this latter finding shall be evaluated knowing that acceptable alpha can be close to .60 when scales count less than four items (16).

CONCLUSION

This study confirms with some adjustments the factorial structure of the VSSS. The results indicate five dimensions (25 items): Psychiatrists/Psychologists' skills and behaviour, Nursing staff/social workers' skills and behaviour, Information and access to services, Services efficacy, Relatives' involvement. Even if the Type of interventions dimension was not retained in the model, we suggest preserving it for eventual clinical evaluation based on each item. We also suggest, for future studies, the adaptation of the VSSS-54F to the European version, VSSS-EU. Indeed, the results of our study sustain the European version because the VSSS-EU is more focused since it separates the skills and behaviour of psychiatrists, psychologists, nurses and social workers (e.g. items 3a and 3b or items 22a and 22b). The next step in the validation process would be to measure Inter-rater and test-retest reliability as well as concurrent, convergent and discriminant validity of the VSSS-EU. Furthermore, a multicultural comparison of the VSSS-EU would be required if the instrument is used for interesting comparisons of survey.

[Suicide prevention strategy and recent data on treatment of depression: obstacles encountered]

Until recently, national strategies have not demonstrated their effectiveness in preventing suicide. A recent series of studies have shown that more aggressive treatment of depression in the population is associated with a significant reduction in the rate of suicide. Proof that a population-based strategy for preventing suicide can be effective should be demonstrating that an etiological factor can be identified on the population level and on the individual level and that this causal factor can be corrected on the individual level. Pertinent data can be put forward and in general demonstrate that treatment of depression is an effective means of preventing suicide on the population level.

Are UN peacekeepers at risk for suicide?

Media reports connecting UN peacekeeping duties by Canadian soldiers to their subsequent suicide prompted this study of peacekeeping as suicide risk. In a case-control design we retrospectively compared 66 suicides in the Canadian military between 1990 and 1995 with two control groups: (a) 2,601 controls randomly selected from the electronic military database and (b) 66 matched controls with complete personnel and medical data. We found no increased risk of suicide in peacekeepers except among a subgroup of air force personnel. Here confounding individual factors, isolation from supports, and possibly inadequate preparation for deployment elucidated their suicides. Theater of deployment (e.g., Bosnia) did not affect the suicide rate. Military suicides experienced psychosocial stresses and psychiatric illness more often than their matched controls. We conclude that although peacekeeping per se does not increase overall suicide risk, military life-styles may strain interpersonal relationships, encourage alcohol abuse, and contribute to psychiatric illness and suicide in a minority of vulnerable individuals irrespective of peacekeeping assignment. Careful selection, and preparatory military training that encourages intragroup bonding and mutual support, may protect against suicide risk.

Spectral editing in solid-state NMR using scalar multiple quantum filters

In this paper we describe the use of heteronuclear scalar couplings in solid-state NMR in order to generate multiple-quantum filtering (MQF) pulse sequences. These sequences can be used to edit CP/MAS spectra according to carbon multiplicity. Analytic expressions for the intensity of the MQF signals are obtained using the standard product operator formalism. Experiments that demonstrate the technique are shown in powder samples of camphor and a tripeptide.

Improved resolution in proton NMR spectroscopy of powdered solids

We present a new solid-state nuclear magnetic resonance experiment that yields, under CRAMPS decoupling conditions, a significant reduction in proton line widths for powdered organic solids. This experiment which relies on a constant-time acquisition of the proton transverse magnetization, removes the contribution of nonrefocusable broadening from the proton line widths. Although this new technique suffers from relatively low sensitivity, we demonstrate in this paper its feasibility on two model samples, L-alanine and the dipeptide Ala-Asp. In both cases a factor of between 2 and 3 in line width reduction is obtained for most of the proton resonances.

Synthesis of deuterium-labeled cryptophane-A and investigation of Xe@cryptophane complexation dynamics by 1D-EXSY-NMR experiments

We present the synthesis of a series of deuterated cryptophanes 2-6 by a slightly modified procedure used for cryptophane-A. We show that for [Xe@cryptophane] complexes the use of variable-temperature one-dimensional 129Xe magnetization transfer (1D-EX-SY) allows the measurement of exchange rates. From these data the decomplexation activation energy Ea has been estimated to be 37.5+/-2 kJ mol(-1). The decomplexation activation enthalpy, deltaH(++) = 35.5+/-2 kJ mol(-1), and entropy, deltaS(++) = -60+/-5 J mol(-1) K(-1), have also been calculated. The calculated negative activation entropy suggests that the activated complex associated with decomplexation is conformationally more strained than the complex in its ground state.

Through-bond heteronuclear single-quantum correlation spectroscopy in solid-state NMR, and comparison to other through-bond and through-space experiments

A new through-bond carbon-proton correlation technique, the MAS-J-HSQC experiment, is described for solid-state NMR. This new pulse scheme is compared experimentally with the previously proposed MAS-J-HMQC experiment in terms of proton resolution on a model sample of powdered L-alanine. We show that for natural abundance compounds, the MAS-J-HMQC and MAS-J-HSQC experiments give about the same proton resolution, whereas, for (13)C-labeled materials, narrower proton linewidths are obtained with the MAS-J-HSQC experiment. In addition we show that in scalar as well as in dipolar heteronuclear shift correlation experiments, when the proton chemical shift is encoded by the evolution of a single-quantum coherence, the proton resolution can be enhanced by simply adding a 180 degrees carbon pulse in the middle of the t(1) evolution time.

TPH and suicidal behavior: a study in suicide completers

An association between the gene that codes for tryptophan hydroxylase (TPH)-the rate-limiting enzyme in the synthesis of serotonin-and suicidal behavior has been investigated with some detail in samples of living subjects who attempted suicide. In this study, we investigated TPH and suicide completion, the most severe form of suicidal behavior. A relatively large sample of suicide completers (n = 101) was genotyped at three TPH loci (two polymorphisms in the promoter region, A-6526G and G-5806T, and one in intron 7, A218C) and compared to psychiatrically normal living controls (n = 129). Although no significant differences were found between groups for genetic variation at single loci, haplotype analysis revealed that one haplotype (-6526G -5806T 218C) was significantly more frequent among suicide cases than in normal controls (chi(2) = 11.30, df = 2, P = 0.0008; OR = 2.0 CI: 1.30-3.6). Further analyses suggested that this haplotype is particularly more frequent among subjects who committed suicide using violent methods. Similar results were observed in recent haplotype analyses in suicide attempters, which found that the equivalent of haplotype -6526G -5806T 218C was more frequent in impulsive attempters (Rotondo et al, Mol Psychiatry 1999; 4: 360-368). Our results replicate in suicide completers previous data observed in suicide attempters. These and other results continue to point to the substantial role that the gene that codes for TPH may play in the neurobiology of suicidal behavior.

Kirkinine, a new daphnane orthoester with potent neurotrophic activity from Synaptolepis kirkii

The bioassay-guided fractionation of a dichloromethane extract from the roots of Synaptolepis kirkii using neuronal viability as a model allowed the isolation of the new daphnane orthoester kirkinine (1a) as a powerful neurotrophic constituent.